【医脉通-指南】2015+AHPBA专家共识声明：肝门部胆管癌.pdfVIP

DOI:10.1111/hpb.12450 HPB ORIGINAL ARTICLE Hilar Cholangiocarcinoma: expert consensus statement John C. Mansour1, Thomas A. Aloia2, Christopher H. Crane3, Julie K. Heimbach4, Masato Nagino5 Jean-Nicolas Vauthey2 1Division of Surgical Oncology, University of Texas Southwestern, Dallas, TX, USA, 2Departments of Surgical Oncology and 3Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA, 4Department of Surgery, Mayo Clinic, Rochester, MN, USA, and 5Department of Surgery, Nagoya University, Nagoya, Japan Abstract An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists met on 15 January 2014 to review current evidence on the management of hilar cholangio- carcinoma in order to establish practice guidelines and to agree consensus statements. It was estab- lished that the treatment of patients with hilar cholangiocarcinoma requires a coordinated, multidisciplinary approach to optimize the chances for both durable survival and effective palliation. An adequate diagnostic and staging work-up includes high-quality cross-sectional imaging; however, pathologic con?rmation is not required prior to resection or initiation of a liver transplant trimodal treat- ment protocol. The ideal treatment for suitable patients with resectable hilar malignancy is resection of the intra- and extrahepatic bile ducts, as well as resection of the involved ipsilateral liver. Preoperative biliary drainage is best achieved with percutaneous transhepatic approaches and may be indicated for patients with cholangitis, malnutrition or hepatic insuf?ciency. Portal vein embolization is a safe and effective strategy for increasing the future liver remnant (FLR) and is particularly useful for patients with an FLR of 30%. Selected patients with unresectable hilar cholangiocarcinom